Introduction:
Bovine pericardial valves, featuring internally or externally mounted leaflets, are commonly used for aortic valve replacement (AVR) and have a service lifespan of 15 years or more (1)(2). The Trifecta valve (Abbott, St Paul, MN, USA) has externally mounted leaflets that impart excellent hemodynamic performance compared to internal leaflets (3). However, early structural valve deterioration (SVD) has been recently reported in first- and second-generation valves (4)(5)(6). Here, we detail two catastrophic early SVD cases in Trifecta valves with multiple-leaflet tears. Both the patients and his families provided informed consent for the publication of this report.